The present invention relates to integrating radiological and pathological information, and more particularly to integrating information from radiological scans, such as but not limited to magnetic resonance (MR), computed tomography (CT), positron emitted tomography (PET), and ultrasound (US) scans, and pathological information derived from biopsy samples for diagnosis, therapy selection, and treatment or disease monitoring.
In conventional clinical workflows, physicians perform biopsies of suspicious lesions or masses. For example, a urologist may perform a transrectal random-core biopsy of the prostate gland in order to search for cancerous tissue samples in patients with high prostate-specific antigen (PSA) blood test results. Specimens from the biopsy are sent to a pathology laboratory, where a pathologist generates a diagnosis in a written report that goes back to the referring physician and an oncologists, who determines the results to be concordant or discordant with other clinical indicators, such as radiological imaging findings from a radiologist. The oncologist then recommends appropriate management based on all the findings.
In the exemplary conventional workflow above, there it can be difficult to effectively communicate, perform correlation, and gather consensus of findings' concordance. These difficulties are primarily due to physical separation, geographic constraints, time, resources, and labor. Also, there is no access to larger sets of data with the known outcome, from which a clinician can draw resemblances and similarities for better final diagnosis and clinical decisions.
Recently, there have been attempts to introduce an updated digital pathology consultation protocol, which is described as follows. The radiologist informs the pathologist of cases that need to be discussed in a conference via an email message. The pathologist selects representative slides for scanning by a digital pathology system that can capture images of entire slides. During the conference digital microscopic images are accessed remotely and simultaneously on desktops of as many individuals as needed using digital pathology information management software. Corresponding radiological studies are uploaded to the radiologist's desktop via a radiology picture-archiving communications system (PACS). The entire diagnostic team including radiologists, pathologists, and surgeons, as well as nurses, residents, and students communicate with each other via a video conferencing system, which, in combination with a Web camera and linked computers, allows video conference sharing of desktop items, including radiological images, while maintaining an opportunity to communicate with and see each other electronically.
While the recently proposed system facilitates much need communication, it falls short in many aspects. For example, it is nearly impossible to establish spatial correlation between biopsy samples and groups of pixels within radiological images, meaning that one cannot tell where the biopsies were taken relative to the anatomical information provided by the radiological images. This can be a cause of discordance, for example, for micro-calcifications in breast cancer cases. Another cause of discordance is inter and intra operator variability, which can cause the need for repeat biopsies. When discordance between the radiological imaging and the histology cannot be resolve, an expensive surgical procedure may be required.